Acute Pain Management

Answer

1. Introduction

   1. Research Problem: Research problem that initiated the study is poor management of acute pain in Lebanese hospital. Pain is considered as the ‘fifth vital sign’; hence, appropriate management of pain can promote patient outcomes (Ramia et al., 2017).
   2. Research Goal: The goal of the study was to identify some of the factors contributing to poor management of acute in surgical patients so as to improve outcomes and patient satisfaction of care (Ramia et al., 2017).
   3. Hypothesis: There was lack of a well-structured approach for management on acute pain in Lebanese hospitals; therefore, there was the need for conducted of further research (Ramia et al., 2017).
   4. Research Questions:
   1. What is the patient’s rating or description of their acute pain intensity before and afte undergoing surgical procedures?
   2. What is the patient’s perception and attitude towards their pain management during hospitalization?
   • What is patient’s overall satisfaction with pain treatment?
   1. Research Method: The authors conducted a prospective cross-sectional study between Oct 2014 and Mar 2015 in three medical centers in Beirut, Lebanon (Ramia et al., 2017).
   2. Sample: Non-random sampling technique was applied in recruitment of research participants using convenient sampling technique. Participants comprised of 177 patients on orthopedic services and 119 women on maternity services.
   3. Variables: Attitude towards pain management as well as preferences and expectations; pain characteristics including intensity and patient satisfaction with pain management (Ramia et al., 2017).
   4. Tools: Questionnaires were used data collection tools. Data was analyzed using descriptive statistics and categorical variables were analyzed using Pearson 𝜒2-test and alternatively using Fischer’s exact test in cases where the expected cell count was <5 (Ramia et al., 2017).
   5. Main Findings: Unfavorable pain management practices that were identified from the study included lack of pain assessment before administration of pain medications, ≥30 minutes delay before administration of pain medications, lack of documentation of the pain score on medical charts (Ramia et al., 2017). Major barriers to effective pain management include fear of adverse effects of pain medications, tolerance, addiction, fear of cost, lack of competent pain providers, lack of knowledge among patients on pain issues, and the belief that pain is inevitable (Ramia et al., 2017).
   6. Conclusion: Pre-operative and post-operative pain remain as a predominant problem in hospital setting, which requires joint efforts and consensus to improve patient’s experience, satisfaction and perception of pain management.

    

    

    

    

    

    

   Acute Pain Management

               In the study titled “Patient perception of acute pain management: Data from three tertiary care hospitals” by Ramia et al. (2017), to assess patient’s experience and perception of acute pain management. The objectives of the study were to evaluate how patients describe intensity of their acute pain, their attitudes, towards management of pain during hospitalization, and overall patient satisfaction with treatment of pain (Ramia et al., 2017). The study is important since it informs management approaches for acute pain to improve outcomes and promote patient satisfaction of care. Healthcare professionals need to respond to effectively evaluate acute pain first and provide timely and appropriate response. It was a questionnaire-based study, in which questionnaires were administered to 177 patients placed on orthopedic services and 119 women placed in maternity care services (Ramia et al., 2017). The survey was conducted between Oct 2014 and Mar 2015 in three medical centers in Lebanon. Pain management before and after surgical operations, need to be improved further so as to improve patients experience and satisfaction of care (Ramia et al., 2017). Findings are open for generalization due to use of a large sample (n=296).

               Research problem that initiated the study is poor management of acute pain in Lebanese hospital. Pain is considered as the ‘fifth vital sign’; hence, appropriate management of pain can promote patient outcomes (Ramia et al., 2017). Holistic approach of pain management includes family involvement and input, collaborative development of the care plan, and comprehensive screening and assessment of pain. Pain maintains the right to receive adequate management of pain and this poses a major challenge for healthcare provider to act in a timely and appropriate manner (Ramia et al., 2017).

   The goal of the study was to identify some of the factors contributing to poor management of acute in surgical patients so as to improve outcomes and patient satisfaction of care (Ramia et al., 2017). The authors did not provide the hypothesis of the study but the study was informed by recommendations from previous research studies that identified that there was lack of a well-structured approach for management on acute pain in Lebanese hospitals; therefore, there was the need for conducted of further research. The authors appeared to have responded to this call for future research on the issues in the area. Similarly, the investigators did not specify any research questions but research objectives are enough to inform the reader about the direction and the issue being interrogated in the study (Ramia et al., 2017). 

               Ramia et al.’s (2017) conducted a prospective cross-sectional study between Oct 2014 and Mar 2015 in three medical centers in Beirut, Lebanon.  Methodology involved use of questionnaires as data collection tools (Ramia et al., 2017). Questionnaire as a data collection tool may contribute of validity of the research findings; however, reliability of the instrument may not be ascertained since research participants may have provided favorable responses or overrating pain intensity than how they actually felt in reality. Data that was captured in questionnaires include patient’s description of the intensity of their acute pain, attitude about pain management, and their satisfaction with pain treatment. Responses from participants were reported using descriptive statistics. Categorical variables were analyzed using Pearson 𝜒2-test and alternatively using Fischer’s exact test in cases where the expected cell count was <5 (Ramia et al., 2017).

               Non-random sampling technique was applied in recruitment of research participants. A convenient sample was used since participants who meet the inclusion criteria were just asked to participate in the study on voluntary basis. The sample involved 177 patients on orthopedic services and 119 women on maternity services. Each participant was informed about the aim and the objective of the study before their involvement in the study. Variables of interest, in which participants were required to fill anonymously in the questionnaire, included attitude towards pain management as well as preferences and expectations; pain characteristics including intensity and patient satisfaction with pain management (Ramia et al., 2017).

               Main findings indicate that 37% of orthopedic patients (n=177) and 50% of the obstetric patients (n=119) reported that their acute pain was at the highest severe intensity.  Unfavorable pain management practices that were identified from the study included lack of pain assessment before administration of pain medications among 30.5% of orthopedic and19.3% of obstetric patients. Another identified unfavorable practice in management of acute pain was ≥30 minutes delay before administration of pain medications among 11.3% among orthopedic and 14.2% among obstetric patients (Ramia et al., 2017). The other unfavorable pain management practice was lack of documentation of the pain score on medical charts in 93.2% of orthopedic patients and 95% of obstetric patients. Fortunately, 89.2% of orthopedic patients and 94.1% of the obstetric patients were satisfied-to-strongly satisfied with their pain management (Ramia et al., 2017).

               Major barriers to effective pain management that were identified in the study include fear of adverse effects of pain medications, tolerance, addiction, and fear of cost.  Other issues that contribute to poor management of acute pain include lack of competent pain providers, lack of knowledge among patients on pain issues, and the belief that pain is inevitable (Ramia et al., 2017). Inaccessibility to pain management professionals was also reported as a major issue that contributes to poor pain management. Some patients are reluctant to report pain or take pain medication. Effective communication between health care providers and patient should not be underrated since it has positive impact in pain management (Ramia et al., 2017).

               In conclusion, pre-operative and post-operative pain remain as a predominant problem in hospital setting, which requires joint efforts and consensus to improve patient’s experience, satisfaction and perception of pain management. It is strongly recommended that healthcare institutions tom implement procedures and policies so as to mandate continuous pain documentation and assessment. Better research findings can be achieved through recruitment of a larger sample size to limit subject and reporting bias.

    

    

Answer

Assessing Risk and Reward

The Nissan Motor Company is one of the leading automobile makers in the world. The Japanese carmaker has primarily enjoyed a successful run, allowing it to enter various regional and international markets such as the United States. However, the changing business environment was not favorable to the company in 2019. Notably, the cooperation recorded losses amounting to 7.8%. The experience pushed the management into making tough decisions, requiring almost all of its North American workforce to go for unpaid leaves.

In late 2019, the company announced that the decline in sales necessitated a two-day unpaid leave for the North American workers. The stated days for the vacation were January 2 and 3^rd    (Chicago Tribune, 2019).  Notably, this move was a crucial decision for the company because of its conflicting impacts. Whereas on the positive side, it could help the firm minimize expenses, it threatened to affect the public perception of the company regarding employee welfare.

The rewards for the decision involved cutting expenses by not paying the workers on leave, which eventually would translate into reduced expenses. Another reward was that the decision could allow the company to optimize performance by evaluating employee performances then developing new milestones. However, on the low side, the company risked affecting its public image and brand name, especially in the North American market. As per Chakravorti (2010), the way an organization treats its employees influences the firm's public perception. Thus, Nissan risked eliciting a negative public perception. With a distorted public image, the company could fail to revive its declining sales.

I would have advised the management of Nissan to utilize the Predictive Analytic perspective in determining the right decision to take. Ideally, the approach tries to predict what might happen in the future if particular decisions or actions are undertaken at the moment (Traymbak & Aggarwal, 2019). Looking at the situation at Nissan, the company needed to develop a goal such as increasing sales. After that, they would have made decisions aimed at realizing the set goal. In this regard, the predicted outcome could give the management an overview of whether more risks existed or significant rewards could be realized.

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